Flexible, Patient-centered Approach Can Help Vets Better Manage Chronic Mental Illness, Study Suggests

BUFFALO, N.Y. -- For veterans who have returned from conflicts overseas, fighting mental illness once home can be overwhelming. Often there are multiple medications prescribed for specific times throughout the day and adding to that are the medications that must be taken for chronic physical problems.

A new study from the University at Buffalo School of Nursing suggests that veterans who have long-term mental illness could achieve better health outcomes if they are offered a flexible, tailored approach to self management of their medications and care.

The researchers call this approach the Recovery Resource System, which they describe in the current issue of the Archives of Psychiatric Nursing.

"This system focuses on behaviors and strategies to encourage active participation of the patient in his own care; it can result in better self-management overall," says Deborah S. Finnell, DNS, RN, UB assistant professor of nursing and primary investigator of the study.

Finell's study is unique because while various systems have been developed by researchers for patients, no studies have been identified in which they were developed with patients.

"As a nurse practitioner, I have learned a lot from my patients," says Finnell. "For example, if I prescribed a medication that should be taken several times a day, I want to hear from the patient about his or her daily activity. Together, we can discuss the optimal times for their medications rather than having me dictate the administration schedule. This collaborative approach is more likely to result in taking the medication as intended."

The study interviewed outpatient veterans who were on long-term mental health medications about what kinds of tools would help keep them on track to take their medications as prescribed and which would be easy for them to use. The study had two phases: the development of the system using comments from 19 veterans in focus groups, and then feedback on the Recovery Resource System from 15 veterans in focus groups.

According to the findings, veterans wanted the Recovery Resource System to be: flexible, able to be tailored to individual needs; dynamic or able to change in response to a new program; adaptable or able to be modified for use in different situations; user-friendly, not complicated; and able to address overall health needs, which would allow for information about diet, diagnosis and clinician to be listed.

From the interviews with veterans, Finnell and her colleagues were able to assemble five factors that would influence the content of the Recovery Resource System. These factors are self-management, patient participation, shared decision-making, personal health care and provider skills.

Finnell notes, "We approached the veterans in this study as experts -- and they are. Their day-to-day experiences in managing their health effectively and, at times, not so effectively, were essential in the development of the Recovery Resource System. The system's information, worksheets and other materials could be useful for anyone who wants to take an active role in self-management of health. The material clearly is designed to foster collaboration between the patient, the family and his or her health care providers."

Finnell would like health care providers using this resource to be aware of the relatively short period of time they have to influence patients and to "urge patients to be smart managers of their health by asking questions about their response to medications and other treatments."

The next step in the research will be to disseminate and evaluate the Recovery Resource System, which will include measures for each of the five components of the patient-centered perspective.

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system that is its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities. The School of Nursing is one of five schools that constitute UB's Academic Health Center.